Medical Conditions Which Affect Weight: Separating Fact From Fiction
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rankinsect wrote: »MondayJune22nd2015 wrote: »The problem with weight loss for me is determining what exactly is my CICO. MFP & every other website, that I've come across; is calculated according to the average person instead of an individual. It doesn't include disabilities, medications, etc., which would alter someone's CICO beyond height, weight, common sedentary levels, etc. For instance when my disability makes me sleep for 20 hours, in a day or leaves me bedridden from weakness, for a day; obviously I am going to require less calories than someone whom spends most of their day sitting & conscious or when I don't defecate for 3 weeks but yet am not suffering from constipation either.
There is a tool (Excel spreadsheet) that lets you measure your actual observed TDEE. You need accurate logs, regular weigh-ins (ideally daily), and a decent history on MFP, but it smooths your weight loss, looks to your calories eaten per day, and tries to estimate your actual calories burned. Essentially it calculates in reverse - given your observed calories and observed rate of loss, what must your TDEE be to get that rate of loss?
http://www.myfitnesspal.com/blog/EvgeniZyntx/view/mfp-data-export-tool-the-overview-659927
I use that periodically to make sure I'm on track and adjust my intake, as I use a TDEE method rather than count exercise calories directly.
Is this a paid version only thing or available for all?0 -
CoffeeNCardio wrote: »rankinsect wrote: »MondayJune22nd2015 wrote: »The problem with weight loss for me is determining what exactly is my CICO. MFP & every other website, that I've come across; is calculated according to the average person instead of an individual. It doesn't include disabilities, medications, etc., which would alter someone's CICO beyond height, weight, common sedentary levels, etc. For instance when my disability makes me sleep for 20 hours, in a day or leaves me bedridden from weakness, for a day; obviously I am going to require less calories than someone whom spends most of their day sitting & conscious or when I don't defecate for 3 weeks but yet am not suffering from constipation either.
There is a tool (Excel spreadsheet) that lets you measure your actual observed TDEE. You need accurate logs, regular weigh-ins (ideally daily), and a decent history on MFP, but it smooths your weight loss, looks to your calories eaten per day, and tries to estimate your actual calories burned. Essentially it calculates in reverse - given your observed calories and observed rate of loss, what must your TDEE be to get that rate of loss?
http://www.myfitnesspal.com/blog/EvgeniZyntx/view/mfp-data-export-tool-the-overview-659927
I use that periodically to make sure I'm on track and adjust my intake, as I use a TDEE method rather than count exercise calories directly.
Is this a paid version only thing or available for all?
It's something Evgeni made, so available if you have the right technology.0 -
lemurcat12 wrote: »CoffeeNCardio wrote: »rankinsect wrote: »MondayJune22nd2015 wrote: »The problem with weight loss for me is determining what exactly is my CICO. MFP & every other website, that I've come across; is calculated according to the average person instead of an individual. It doesn't include disabilities, medications, etc., which would alter someone's CICO beyond height, weight, common sedentary levels, etc. For instance when my disability makes me sleep for 20 hours, in a day or leaves me bedridden from weakness, for a day; obviously I am going to require less calories than someone whom spends most of their day sitting & conscious or when I don't defecate for 3 weeks but yet am not suffering from constipation either.
There is a tool (Excel spreadsheet) that lets you measure your actual observed TDEE. You need accurate logs, regular weigh-ins (ideally daily), and a decent history on MFP, but it smooths your weight loss, looks to your calories eaten per day, and tries to estimate your actual calories burned. Essentially it calculates in reverse - given your observed calories and observed rate of loss, what must your TDEE be to get that rate of loss?
http://www.myfitnesspal.com/blog/EvgeniZyntx/view/mfp-data-export-tool-the-overview-659927
I use that periodically to make sure I'm on track and adjust my intake, as I use a TDEE method rather than count exercise calories directly.
Is this a paid version only thing or available for all?
It's something Evgeni made, so available if you have the right technology.
Ah, I see, a dropbox thing, If It ever loads I do have excel0 -
rankinsect wrote: »Technically, if you're adding in exercise separately from activity level, MFP is not calculating TDEE, it's calculating BMR + NEAT (non-exercise activity thermogenesis).
Basically:
BMR - amount of calories you'd burn in a coma
NEAT - extra calories you burn on everything that isn't deliberate exercise (i.e. the extra calories above BMR you burn just living life)
Exercise - extra calories you burn on deliberate exercise.
TDEE, by definition, is BMR + NEAT + exercise, it's the cumulative of all of your calories you expend, period. Some people use MFP in what they call "TDEE method", where they factor all their exercise into their activity level and don't actually log exercise calories, others use the "NEAT + exercise" method, where their activity level is really estimating BMR + NEAT, and they manually add exercise, etc.
If we're really going to be complete, don't forget to count TEF (Thermic Effect of Food) as well in TDEE. It's relatively insignificant in comparison to the others, but it's part of the equation.
BMR + NEAT + EAT (Exercise Activity Thermogenesis) + TEF = TDEE.0 -
Hang on
Doesn't NEAT include BMR?
Eg BMR+ activity level = NEAT
NEAT+ purposeful exercise = TDEE
That's how I have always used it0 -
TEF is clearly redundant and included in BMR0
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Do you all think it's possible that a medical condition and/or medications can slow you down so much that in order to maintain you'd have to eat unsafely meaning less than a 1000 calories?
I am undecided. I wish I had been logging while I was sick so I had a better idea of my calorie consumption. I wasn't eating a lot but that means nothing without seeing the log.0 -
There is a slight problem with the way BMR or RMR, NEAT, and TDEE are being shown in this thread. I am, maybe wrongly, assuming TEF is included in the calculations, and if not, as said above, it is minimal.
BMR ( Basic Metabolic Rate)/RMR (Resting Metabolic Rate) = the bodies activity at rest.
NEAT= non exercise activity Thermogenises.
NEAT = BMR/RMR +daily activity.
This is what MFP uses and you add your exercise to it and eat back a portion of your calories depending on how you are calculating them. But you are to eat them back.
TDEE= Total Daily Exercise Expenditure.
TDEE = BMR/RMR + daily activity+ exercise -or-
TDEE= NEAT + exercise.
you hsve no need to account for exercise, it is included.
Again, I assume that TEF is included in this equation.
A lot of people work off continually reassessing their TDEE. TDEE is built on an assumption of a steady rate of exercise per week. It doesn't matter what you do, but if you enter 5hr cardio per week that is your calories until you change to a lower or higher workout volume per week.
If one is more varied in what they expend per week in exercise, that is when using the NEAT method comes to the fore. It allows for variation. TDEE if used correctly assumes a constant.
How you work out determines which method is best for you.
TDEE uses an outside calculator; NEAT uses MFP's
Sorry to be so pedantic, but a lot of posts get the terminology confused and think MFP is calculating TDEE. It isn't.
Eat your exercise calories if you are computing your goals through MFP alone.
Cheers, h.0 -
Hang on
Doesn't NEAT include BMR?
Eg BMR+ activity level = NEAT
NEAT+ purposeful exercise = TDEE
That's how I have always used it
I guess it all depends on who's categorizing/discussing it. In one of Lyle McDonald's articles entitled The Energy Balance Equation, he lays it out as such:...Summing up, there are 4 primary aspects of the energy out part of the equation which are Resting/Basal Metabolic Rate (RMR/BMR), the Thermic effect of food (TEF), the Thermic Effect of Activity (TEA) and a more recent addition which is Spontaneous Physical Activity/Non-Exercise Activity Thermogenesis (SPA/NEAT). Essentially TEA refers to calories burned through formal exercise/activity, SPA/NEAT is more subconscious and represents daily movement, going from seated to standing, fidgeting and a host of other stuff that isn’t conscious voluntary exercise...
As an aside regarding TEF, he states further down in the article:...The Thermic effect of food is related directly to the amount of food that you’re eating. Now, TEF is usually rough-estimated at 10% of total food intake (this is just an average value for average diets). But that means that if you reduce food intake by 500 cal/day, you will be burning 50 cal/day less via TEF. Your previous maintenance of 2500 has already been reduced to 2450 cal/day. So the assumption of a static 2500 cal/day maintenance is already made invalid simply by the act of reducing food intake (albeit slightly)...
I'm sure somebody can find a different reference to it in which they categorize things differently; include TEF in BMR, include BMR in NEAT, etc. But in the technical sense, one could argue that TEF isn't part of BMR because eating is an activity above and beyond basal support mechanisms. Either way, it's probably pedantry and majoring in the minors, so I won't go any further with it.0 -
I was treated with psychiatric medications that resulted in me gaining a lot of very quickly. The meds caused me to be starving hungry and I over ate, like seriously over ate. The weight gain was still the end result of CI-CO but the medication and my mental health contributed significantly.0
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I'm going to give a case example in weight gain where morbid obesity is due to factors largely beyond the person's control. My mom is morbidly obese because of a confluence of factors. She pretty much "won" the jackpot on medical problems. You see, her mother took a particular drug, during pregnancy that turned out to cause some very serious health problems in unborn children.
- Cushing's Syndrome
Her form is endogenous, meaning its not caused by a tumor (and is therefore nonoperable). Her cortisol levels are sky-high all the time, which has messed up a number of metabolic pathways and signaling cascades in her body. Most significantly, the cortisol imbalance causes both enormous hunger and the ability of the body to create fat out of next to nothing. With Cushing's, your body will actually prioritize storing fat over pretty much anything else. Plus it makes you hungry. Living with hunger is no easy thing. It's the primary reason that most diets are unsustainable.
When she developed the Cushing's Syndrome, she gained over 100 lbs in the space of six months. I remember going to the doctor with her as a child, and the doctor told her, to her face, that there was nothing wrong with her, and that she was a "fat pig" and "hypochondriac" (yes, he called her that) who "stuffed her face." He told her to go home, quit eating so much and stop making things up. It was almost 20 years later before a physician actually looked at her and said "How long have you had Cushing's?" and then set up the referrals to the Mayo Clinic, who confirmed the diagnosis but unfortunately were unable to find a treatment plan for her.
This undiagnosed condition led to a host of other issues, including the next major cause of her morbid obesity. - Kidney failure and Heart failure
Kidney failure causes a retention of water. In my mom's case, this is exceptionally severe. She has trouble breathing because water does not clear from her lungs due to poor circulation, and her legs ooze fluid because her kidneys aren't filtering it out. Her skin is tight and shiny and easily broken or infected as a result.
Her doctor estimates that she's carrying around 100 lbs of retained water. I believe this, because when they have put her on aggressive diuretic regimens in the past she's lost as much as 70 lbs within 2 weeks. Unfortunately, as soon as the diuretics are discontinued it pretty much all comes back, and its unsustainable as they also degrade what little remaining kidney function she has.
Technically those aren't the only organs she has failing (she has liver failure as well), but her organs are the victims of three different diseases:- Systemic Scleroderma
- Systemic Lupus Erythematosus
- Type I Diabetes Mellitus
It is especially notable that my mother's diabetes was diagnosed as a child, but because her parents were farmers who would lose their health insurance for the whole family, they did not treat her for the condition. Instead, my grandmother would test her urine sugar daily, and if she was spilling high levels, she'd only be allowed to eat two hard-boiled eggs for the day. All in all, it was pretty awful diabetes management that continued until she was in her mid-thirties (when we took her to the ER because she was nearly comatose. Her blood sugar was over 400. Not one physician had tested her blood sugar as an adult to that point!).
- Giant abdominal fibromas
My mother's physician estimated last May that she was carrying around more than 150 lbs of gigantic fibromas. These are benign (noncancerous) tumors, but they are exceptionally aggressive. Unfortunately, removing them only triggers more growth, and with her very poor wound healing as well as general ill health she's been told she just has to live with them. These tumors are growing throughout her abdomen as well as two external tumors, one of which is larger than a cantaloupe. - Loss of mobility.
Being sedentary is a distinct problem for the calories-in/calories-out balance. Until she lost her mobility, while a large woman, my mom was of a manageable weight such that she could enjoy limited exercise, maintaining the house and garden, and getting out. Now she's entirely housebound and dependent upon assistance for everything. There were multiple causes of her loss of mobility, each one playing a significant and painful role.- Multiple Sclerosis
While not a "cause" of weight gain, I suggest someone try to actually walk or move for exercise when suffering from uncontrollable spasms. When this condition interfered with her balance enough to require a walker, her weight really started going up. - Osteoarthritis
This has always been a challenge for my mom. Her arthritis, present since early childhood, made moving around quite painful. - Osteopetrosis of the spine.
This is a congenital problem (at birth) where her bones are super-dense, and very brittle. Excessive remodeling of her spine, causing pinching of the nerves, has occurred where she sustained a few injuries as a teen and young woman. This led to limited ability to bend or twist, or bear weight. - Congenital hip dysplasia.
No, this isn't only a condition your purebred dog suffers from.. humans have this problem too. As a result of the misaligned hip joint, her hips tend to "fall out of joint", that is, her femur can dislocate very easily from the hip socket. It's about as pleasant as you might expect. - Strokes
Mom's had at least 4 of them now over the past 2.5 years. They've partially paralyzed half her body. She's really not getting around much at all; getting her onto her toilet which is right next to her chair is almost impossible some days when she's really weak.
- Multiple Sclerosis
I have witnessed countless hostile actions and things people have said to, around, and about my mother over the years regarding her weight. From the doctor who sighed and asked my father "You're a skinny man, how did you let this happen to your wife?" (That she got so fat) to the woman who pointed at my mom while telling her daughter "Look at that disgusting woman. That's what happens when you eat like a pig!", to people who harassed her for using a mobility cart in the stores when she could still get out of the house. Every one of the people thought they were justified in their rudeness. Some thought that their hostility would help her, would motivate her to lose weight. Really, it was none of their business and their presumption showed how ignorant they were.
Being overweight, even obese, was no major problem for Ma as long as she was able to be active. However, when her other health conditions made her sedentary, the weight just started piling on. And then she became nearly completely immobilized, and her weight makes accomplishing little daily things, like going to the bathroom, or getting into a car (with assistance!), really, really hard.
My mom weighs about 475 lbs. Of that, about 250 are directly due to water retention and tumors. Before her significant height loss (due to spine degeneration) her height was 5'11". She would be around 225 lbs ... "obese", but barely, without them. "Calories-in/calories-out" rules the day. But sometimes life just really makes winning on that equation pretty much impossible.0 - Cushing's Syndrome
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@tomteboda Reading your Mum's story is heartbreaking, just heartbreaking. I am so sorry for what she must be going through. She would feel very blessed to have your unconditional love, support and understanding.
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midwesterner85 wrote: »rankinsect wrote: »midwesterner85 wrote: »In any event, it would be like asking everyone to acknowledge that CICO is not absolute even after it's been proven to be flawed. As much as I can try, it isn't going to happen even when some argue that it is absolute because the flaw occurs in a minority of cases (which acknowledges the flaw while simultaneously denying it).
CICO isn't flawed. Medical conditions can either change CI or CO, but they can't change physics; the total amount of energy is remaining constant in the absence of any nuclear fission or fusion occurring in your body.
Ultimately, calories lost because of epithelial malabsorption, calories lost from glycosuria, proteinuria, or lipiduria, etc. are all "calories out", as it's energy-containing substances that leave the body.
"Calories out" is not exactly the same as "calories burned", although in most people it's quite close.
It depends on definition. Most posts I've seen mentioning CICO were based on the definition of CO being RMR + exercise. That seems to be the consensus on the MFP forums.
No, it's not. That's your assumption. I have repeated and keep repeating and many other posters will keep telling yo that all these other things that rankinsect mentioned are included in it.
I wish I could click a like button, rankinsenct was spot on.0 -
rankinsect wrote: »midwesterner85 wrote: »In any event, it would be like asking everyone to acknowledge that CICO is not absolute even after it's been proven to be flawed. As much as I can try, it isn't going to happen even when some argue that it is absolute because the flaw occurs in a minority of cases (which acknowledges the flaw while simultaneously denying it).
CICO isn't flawed. Medical conditions can either change CI or CO, but they can't change physics; the total amount of energy is remaining constant in the absence of any nuclear fission or fusion occurring in your body.
Ultimately, calories lost because of epithelial malabsorption, calories lost from glycosuria, proteinuria, or lipiduria, etc. are all "calories out", as it's energy-containing substances that leave the body.
"Calories out" is not exactly the same as "calories burned", although in most people it's quite close.
I want to embroider and frame this post.0 -
CoffeeNCardio wrote: »midwesterner85 wrote: »rankinsect wrote: »midwesterner85 wrote: »In any event, it would be like asking everyone to acknowledge that CICO is not absolute even after it's been proven to be flawed. As much as I can try, it isn't going to happen even when some argue that it is absolute because the flaw occurs in a minority of cases (which acknowledges the flaw while simultaneously denying it).
CICO isn't flawed. Medical conditions can either change CI or CO, but they can't change physics; the total amount of energy is remaining constant in the absence of any nuclear fission or fusion occurring in your body.
Ultimately, calories lost because of epithelial malabsorption, calories lost from glycosuria, proteinuria, or lipiduria, etc. are all "calories out", as it's energy-containing substances that leave the body.
"Calories out" is not exactly the same as "calories burned", although in most people it's quite close.
It depends on definition. Most posts I've seen mentioning CICO were based on the definition of CO being RMR + exercise. That seems to be the consensus on the MFP forums.
But isn't it really TDEE - deficit(weekly loss goal dependent) + exercise? Hence the choice you have to make when you pick activity level? Otherwise, most everyone would be set at the same # wouldn't they? I can't imagine we're all at 1200 calorie limits... (yes, I'm really asking the question, not an attempt to disagree)
Well, to function on MFP? Almost. Exercise is already included in TDEE. How your body functions? Close enough for most healthy people.0 -
MondayJune22nd2015 wrote: »PeachyCarol wrote: »Cortisol can have an impact on weight for sure. One reason I think a lot of people don't gain as much weight as they might expect on a vacation is because they lowered their cortisol levels by being relaxed.
One of the reasons it's suggested to take breaks from eating at a deficit is that long term dieting is itself a stressor. I think I might be coming to this point myself.
In addition to cortisol, they might have also increased their activity level, by spending a day at the beach (several hours), swimming, walking, etc., instead of just their typical (1 hour) of daily exercise; of swimming at the gym or walking around their neighborhood or even was busy enjoying something sedentary, to not become bored enough to eat; like they might have otherwise.
I have definitely hit a road block with my weight loss, even though my (known) stress causes haven't increased; in fact they've decreased but I hadn't considered the potential of a deficit stress but it makes sense, since we are subsisting on less; than what's usually optimal. @PeachyCarol so how long do you suppose a break from a deficit, should be? I believe 2 weeks would be sufficient, for me. When returning to one's deficit level, do you think that'd be considered as starting over? Even though one would be technically starting, where they left off; as in no weight gain within that break period & because there'd be no weight gain, do you believe that it's likely that when they restart, that it'd be like a typical 1st week when most initially began? Such as losing pounds of water weight or do you think that it'd just revert to being within the average fat loss, that was taking place; before the deficit break?
I've been looking into diet breaks lately, and the usual recommendations to allow time for the hormones to get back up to appropriate levels is 10 days to 2 weeks. I'm not sure if there'd be weight gain, there might be some glycogen replenishment depending on carbohydrate intake.
I'm not really sure of the fat loss rate once you return to dieting either. I think it would be better since your hormones are in a happier place. At least I hope so.
For me, I'm looking into it because I've been eating at deficit a long time, and I'm having a hard time keeping my head in the game right now due to life stress. (We're moving)0 -
@tomteboda Thank you for taking the time to write and share your post. Your mother's situation is truly heartbreaking.
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This thread has a the feel of a low carb diet argument. Maybe over many redirects, or attempts?
Physical conditions impacting CICO
MY EXPERIENCE:
I weigh almost half what I used to. When I was taking acto plus metformin, it did change the CICO equation efficiency point.
As I lost weight and got in shape I burned calories more efficiently and lowered my resting heart rate. Another change in my personal CICO burn rate.
Now I am on no medication, have a heart rate in the 40's. My doctor has advised I need fewer calories because I am not on the medication, and that we adapt over time in the "efficiency factor".
So that factor is in place in every person. I experienced the medicine effect on that calorie burn efficiency rate and it was pre warned to me by my doctor.
CICO is a function that has a few variables.
It isn't ever voided.
Lots of this thread seems to be arguing ketogenic diet claims.
I like lower carb as my way of eating but not keto. I never had success with any diet not counting calories to apply a basic CICO. There is something about a high protein day once a week that works for me. I can't explain it. I often drop a pound or two after a meat only day. I'm sure there is a good reason. A reason that is not magic or invalidates the premise of calorie expenditure.
Medicines factor in. They don't invalidate the equation
Those with depression have a double whammy. Getting hungry and Eating to try and feel an energy bump and then not wanting to exercise is a tough road.
It can be done. I'm not here to argue minutiae. I have lost my 100+ pounds. Went from desk mushroom to triathlon guy.
Good luck and best wishes to all on reaching their goals.
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PeachyCarol wrote: »MondayJune22nd2015 wrote: »PeachyCarol wrote: »Cortisol can have an impact on weight for sure. One reason I think a lot of people don't gain as much weight as they might expect on a vacation is because they lowered their cortisol levels by being relaxed.
One of the reasons it's suggested to take breaks from eating at a deficit is that long term dieting is itself a stressor. I think I might be coming to this point myself.
In addition to cortisol, they might have also increased their activity level, by spending a day at the beach (several hours), swimming, walking, etc., instead of just their typical (1 hour) of daily exercise; of swimming at the gym or walking around their neighborhood or even was busy enjoying something sedentary, to not become bored enough to eat; like they might have otherwise.
I have definitely hit a road block with my weight loss, even though my (known) stress causes haven't increased; in fact they've decreased but I hadn't considered the potential of a deficit stress but it makes sense, since we are subsisting on less; than what's usually optimal. @PeachyCarol so how long do you suppose a break from a deficit, should be? I believe 2 weeks would be sufficient, for me. When returning to one's deficit level, do you think that'd be considered as starting over? Even though one would be technically starting, where they left off; as in no weight gain within that break period & because there'd be no weight gain, do you believe that it's likely that when they restart, that it'd be like a typical 1st week when most initially began? Such as losing pounds of water weight or do you think that it'd just revert to being within the average fat loss, that was taking place; before the deficit break?
I've been looking into diet breaks lately, and the usual recommendations to allow time for the hormones to get back up to appropriate levels is 10 days to 2 weeks. I'm not sure if there'd be weight gain, there might be some glycogen replenishment depending on carbohydrate intake.
I'm not really sure of the fat loss rate once you return to dieting either. I think it would be better since your hormones are in a happier place. At least I hope so.
For me, I'm looking into it because I've been eating at deficit a long time, and I'm having a hard time keeping my head in the game right now due to life stress. (We're moving)
I'll definitely take a deficit break, once I am no longer overweight (I am only 11 pounds shy of that) & I've only been eating at a deficit since June 22nd (hence my user name), so it seems to soon; to implement a break currently but since I'm small frame, I'll have to be at the lowest healthy weight range for my height; in order to not still look overweight (which is approximately another 35 pounds). For me any longer than 2 weeks, of not losing weight; would be extremely discouraging (even if it's my choice not to, since I haven't reached; my goal weight yet) & I'll also document it, since there're so many important "unknowns"; that I'm curious to learn about.
Since relocating isn't something we do often, like traditional housework; it isn't apart of our daily activity level. Therefore that's exercise in of itself. So you'd possibly still lose weight if you ate at maintenance & didn't do any of your regular exercising.0
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